Provider Demographics
NPI:1316017262
Name:BARNES, JOHN WILLIAM II (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILLIAM
Last Name:BARNES
Suffix:II
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:J
Other - Middle Name:WILLIAM
Other - Last Name:BARNES
Other - Suffix:II
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:107 DOCTORS DRIVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330
Mailing Address - Country:US
Mailing Address - Phone:304-842-6226
Mailing Address - Fax:
Practice Address - Street 1:107 DOCTORS DRIVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330
Practice Address - Country:US
Practice Address - Phone:304-842-6226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV1007152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3104035000Medicaid
WV3104035000Medicaid
BA4102701Medicare PIN